小儿后颅窝肿瘤手术治疗体会

目的:探讨显微外科手术切除小儿后颅窝肿瘤的临床疗效。方法:回顾性研究我科自2009年至2011年收治小儿后颅窝肿瘤17例,采用枕下正中切口,小脑下蚓部切开的传统手术入路术式以及经小脑延髓裂入路显微外科手术切除。结果:肿瘤全切除13例,次全切除4例。1例手术死亡,术后出现小脑缄默综合征及口咽失用1例,经治疗2月后症状基本消除;脑脊液漏1例,经再次加固缝合及加压包扎后治愈。结论:小儿后颅窝肿瘤需采用显微神经外科技术,传统手术入路需切开小脑蚓部,损伤相对较大,术后并发症相对较多。经小脑延髓裂入路可相对减少血管,神经及正常脑组织的损伤,术后小脑缄默综合征等并发症发生率下降,但相对较难掌握。

Experience in Surgical Treatment of Children with Tumors of Posterior Cranial Fossa

Objective:To explore the clinical curative effect of microsurgery of the posterior cranial fossa tumor resection in children.Methods:The clinical data were retrospectively analyzed of 17 children with tumors of posterior cranial fossa admitted from 2009 to 2011.The patients underwent posterior cranial fossa surgery either by traditional surgical approach,using the suboccipital midline incision,or by cerebellomedullary fissure approach.Result:Of the 17 cases,13 got total tumor removal,4 got subtotal tumor removal.One of them died after surgery.Cerebellum silent syndrome and oropharyngeal apraxia occurred in 1 case,after 2 months’ treatment the the symptoms disappeared basically.Cerebrospinal fluid leak occurred in 1 case and was cured after reinforced stitched and bandaged.Conclusion:Children with posterior fossa tumors should choose microsurgical techniques.The traditional surgical approach need to cut the cerebellar vermis,the damage is relatively large,relatively with more postoperative complications.By cerebellomedullary fissure approach can relatively reduce the damage of blood vessels,nerves and normal brain tissue,which can decrease the incidence of postoperative cerebellar silent syndrome and other complications,but it is relatively difficult to master.